Hemoglobin Abnormalities and A1c Testing

I recently saw a patient for a diabetes follow-up and had just gotten her lab values faxed over. Her A1c came back at 9.6 despite the patient telling me that her glucose meter readings were much lower. She even showed me the meter and upon doing some averaging, it appeared that her A1c should be a lot lower.

My first thought was a faulty meter and so immediately we gave her another one but upon first use in the office the glucose readings on each were 122 mg/dl and 128 mg/dl respectively. I had her use the new meter for 7 days and return. The readings on the meter indicated that her A1c should be in the 7.6 range….

Upon further investigation we found that the patient had the sickle cell trait hemoglobin variant. The endocrinologist in the office explained that this and other blood anemias can cause falsely elevated A1c readings, depending on the testing device the labs use.

Sheryl K., RN, CDE

Editors note:

Blood disorders that affect A1c values are more common than we may think. These disorders can include sickle cell trait, thalassemia, and some forms of anemia.

Most people who are heterozygous — having one variant gene and one standard hemoglobin gene — for a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care providers should suspect the presence of a hemoglobinopathy when:

an A1C result is different than expected

an A1C result is above 15 percent

results of self-monitoring of blood glucose have a low correlation with A1C results

a patient’s A1C result is radically different from a previous A1C result following a change in laboratory A1C methods

According to the NGSP — The hemoglobin A1C (A1C) test can be unreliable for diagnosing or monitoring diabetes and prediabetes in people with inherited hemoglobin variants, also called hemoglobinopathies. Hemoglobins S and E are prevalent variants in people of African, Mediterranean, or Southeast Asian descent.

These variants interfere with some A1C tests — both laboratory and point-of-care tests. If A1C tests are at odds with blood glucose testing results, interference should be considered.

Reliable A1C tests that do not cause interference with hemoglobin variants are available. More information about appropriate assay methods to use for hemoglobin variants is available from the NGSP at www.ngsp.org